title: Activated protein C in septic shock: a propensity-matched analysis.
abstract: BACKGROUND
  The use of human recombinant activated protein C (rhAPC) for the treatment of severe sepsis remains controversial despite multiple reported trials. The efficacy of rhAPC remains a matter of dispute. We hypothesized that patients with septic shock who were treated with rhAPC had an improved in-hospital mortality compared to patients with septic shock with similar acuity who did not receive rhAPC.
  
  
  METHODS
  This retrospective cohort study was completed at a large university-affiliated hospital. All patients with septic shock admitted to a 50-bed ICU between July 2003 and February 2009 were included. Patients were treated according to sepsis management guidelines.
  
  
  RESULTS
  A total of 563 septic shock patients were included (110 received rhAPC and 453 did not). Treated and untreated groups were matched in patient characteristics, comorbidities, and physiologic variables in a 1:1 propensity-matched analysis (108 received rhAPC, 108 did not). Mean Acute Physiology And Chronic Health Evaluation II (APACHE II) scores were 24.5 for the matched treated and 23.9 for the matched untreated group (P = 0.54). Receipt of rhAPC was associated with reduced in-hospital mortality (35.2% vs. 53.8%, P = 0.005), similar mean days on vasopressors (2 vs. 2, P = 0.90), similar mean days on mechanical ventilation (9 vs. 8.7, P = 0.80), similar mean length of ICU stay in days (11.0 vs. 11.3, P = 0.90), and similar mean length of hospital stay in days (19.5 vs 27, P = 0.11). No patients in either group had intracranial bleeding; differences in gastrointestinal bleeding and transfusion requirements were not statistically significant.
  
  
  CONCLUSIONS
  Patients in our institution with septic shock who were treated with rhAPC had a reduced in-hospital mortality compared with patients with septic shock with similar acuity who were not treated with rhAPC. In addition, time on mechanical ventilation, time on vasopressors, lengths of stay and bleeding complications did not differ between the groups.
authors.affiliation: St. John's Mercy Medical Center/St Louis University, 621 S New Ballas Rd., Suite 4006B, St. Louis, MO 63141, USA. farid.sadaka@mercy.net
authors.forename: Farid
authors.initials: F
authors.lastname: Sadaka
authors.forename: Jacklyn
authors.initials: J
authors.lastname: O'Brien
authors.forename: Matthew
authors.initials: M
authors.lastname: Migneron
authors.forename: Julie
authors.initials: J
authors.lastname: Stortz
authors.forename: Alexander
authors.initials: A
authors.lastname: Vanston
authors.forename: Robert W
authors.initials: RW
authors.lastname: Taylor
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D016022:Case-Control Studies; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D011486:Protein C / Q000627:therapeutic use*; D011994:Recombinant Proteins / Q000627:therapeutic use; D012189:Retrospective Studies; D012772:Shock, Septic / Q000188:drug therapy* / Q000401:mortality; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D011486:Protein C; D011994:Recombinant Proteins